The importance of gender-affirming care

Gender-affirming care isn’t just about pronouns or hormone blockers. It’s about kindness. It’s about dignity. It’s about saving lives.

That’s why MultiCare is committed to providing gender-affirming care, not just to the children and adolescents treated at the Mary Bridge Children’s Gender Health Clinic, but to every patient, family and health care team member.

“Ideally gender affirming care would be a component of all care we provide for every patient at every encounter,” said Sarah Dryfoos-Guss, program manager with MultiCare’s Center for Health Equity and Wellness. That can be as simple as asking for and using a patient’s pronouns, as well as screening for sexual orientation and gender identity.

There’s an opportunity to honor a patient’s gender identity at every patient encounter. But that’s just where it starts. Equally important, said Dryfoos-Guss, is to “cement our practices across the organization and create an environment that signals we are a safe space and an LGBTQ-friendly space.”

Laurie Lynch, manager of education services for The Rainbow Center in Tacoma identifies as gender queer and says having that acknowledged is just good medicine.

“When I go to the doctor and I am affirmed, it improves my mental health,” they said. “My blood pressure goes down; I don’t feel afraid anymore. I don’t second guess myself. And that’s freeing. Unfortunately, I know that is not what everyone who is transgender or gender queer experiences.”

MultiCare’s commitment to provide training on gender-affirming best-practices is a big deal, according to Lynch. No one expects perfection, they said, but “it’s reassuring that even if folks mess up, they do have the tools to get it right.”

That often means simply acknowledging and apologizing for something like using the wrong pronouns. And trying to avoid making the mistake again. Because for gender non-conforming people, it can be devastating to be constantly mis-gendered.

“There is a plethora of data that says when people are gendered correctly it reduces suicidality by up to 50 percent,” said Dryfoos-Guss.

Beyond offering gender-affirming care in generalized medical settings, Mary Bridge Children’s has offered specialized care for gender non-conforming and trans children for 10 years, and the program is growing.

“When I started in 2019 we had 161 youth,” said Aytch , a social worker with Mary Bridge Children’s Gender Health Clinic. “As of right now we have 340 with 25 on the waitlist.”

Population growth, increased trans visibility and a generational change all contribute to the explosive growth at the clinic.

“I’m 31,” Aytch said. “My generation was breaking down boxes. The generation that’s 10 to-17 now, they don’t even care about the boxes. They know that gender is fluid. They’re more equipped to understand and they want to be who they are. It’s pretty awesome.”

The clinic at Mary Bridge Children’s provides counseling and resources for children and families, along with hormone blockers and hormone replacement therapy with gender health board-certified physicians. The clinic doesn’t offer any surgical treatments, but it can provide resources if that’s something patients want to pursue as adults.

The Mary Bridge Children’s Gender Health Clinic is one of just four dedicated gender health clinics for children and youth in Washington, according to Aytch. The are currently no dedicated gender health clinics for adults. But to help address the needs of LGBTQ+ patients, the MultiCare Center for Health Equity and Wellness is developing a list of MultiCare providers who are screened and approved for providing LGBTQ+ affirming care.

In areas without established gender clinics, youth can find care with individual providers like Sasha Carey, MD, an adolescent and transgender care specialist with MultiCare Rockwood Pediatrics – Spokane Main Clinic.

Dr. Carey says gender-diverse kids are particularly vulnerable because of social and sometimes family pressures.

“The risks that these kids face are so much greater than their peers who are not gender diverse, in terms of mental health,” she said. “We know that the prevalence of suicide or suicide attempts, or major depressive disorder is so much higher for gender-diverse kids.”

Aytch adds that gender diverse youth, due to social stigma and, sometimes, lack of support, are a population that are at risk for adverse behaviors such as homelessness, substance use and food insecurity.

Fortunately, that’s not true for every gender non-conforming kid.

“Some of the families I see, there’s no depression, no anxiety,” Dr. Carey said. “It’s smooth. In these cases, it is a process of becoming your true self.”

No matter how smooth or rocky the journey, providing gender-affirming care is Dr. Carey’s passion. “It’s a calling, really’” she said.

And seeing the outcome is a joy.

“When parents really don’t come on board ever and the kid has to transition alone at 18, it can negatively impact the physical and mental health of these youth and it’s a real loss for the parents,” Dr. Carey said. “They are missing out on something wonderful and life-affirming.”

“It’s really stunning and a beautiful thing to be able to witness,” Lynch agreed.

Much as with the Mary Bridge Children’s Gender Health Clinic in Tacoma, Dr. Carey is also seeing significant growth in the number of gender-divergent patients she sees in the Spokane area. Part of this is likely because health insurance now covers care, but also because there’s a healthier perspective among today’s teens and young adults on both sides of the Cascades.

“This generation is much more understanding that gender, sexuality, race — the ways that society has defined them — is a social construct that is all made up without scientific foundation,” she said.

For parents, it can be harder to accept. That’s why gender-affirming care includes support for the whole family, including providing counseling resources as needed.

Dr. Carey also credits growing research with helping providers like her give ever better care medically.

“The way I practice is changing,” she said. “Especially with puberty blockers for younger kids. It can be really important.”

Likewise, the research is exploding some old, harmful myths.

“It wasn’t too long ago I would have patients tell me about counselors who told them ‘I don’t think this is a thing,’” said Dr. Carey. “That’s not a problem I’ve seen in a while.”

People used to believe that if gender dysphoria didn’t present by the time a child was 4 years old it would not persist. Now it’s clear that a large number of kids don’t present until puberty.

“Treating this is so important,” Dr. Carey said. ”It’s a basic need.”

Aytch, who is gender non-conforming, says they didn’t know gender health clinics existed when they were growing up.

“It would have been a game-changer,” they said. “It’s so, so important. Sometimes it’s life or death for these teens.”

Learn more about Mary Bridge Children’s Gender Health Clinic and MultiCare commitment to LGBTQ+ affirming care.